Differential cardiomyocyte transcriptomic remodeling during in vitro Trypanosoma cruzi infection using laboratory strains provides implications on pathogenic host responses.

BACKGROUND: Chagas disease can lead to life-threatening cardiac manifestations. Regional factors, including genetic characteristics of circulating Trypanosoma cruzi (T. cruzi), have attracted attention as likely determinants of Chagas disease phenotypic expression and Chagas cardiomyopathy (CCM) progression. Our objective was to elucidate the differential transcriptomic signatures of cardiomyocytes resulting from infection with genetically discrete T. cruzi strains and explore their relationships with CCM pathogenesis and progression. METHODS: HL-1 rodent cardiomyocytes were infected with T. cruzi trypomastigotes of the Colombian, Y, or Tulahuen strain. RNA was serially isolated post-infection for microarray analysis. Enrichment analyses of differentially expressed genes (fold-change ≥ 2 or ≤ 0.5) highlighted over-represented biological pathways. Intracellular levels of reactive oxygen species (ROS) were compared between T. cruzi-infected and non-infected HL-1 cardiomyocytes. RESULTS: We found that oxidative stress-related gene ontology terms (GO terms), 'Hypertrophy model', 'Apoptosis', and 'MAPK signaling' pathways (all with P < 0.01) were upregulated. 'Glutathione and one-carbon metabolism' pathway, and 'Cellular nitrogen compound metabolic process' GO term (all with P < 0.001) were upregulated exclusively in the cardiomyocytes infected with the Colombian/Y strains. Mean intracellular levels of ROS were significantly higher in the T. cruzi-infected cardiomyocytes compared to the non-infected (P < 0.0001). CONCLUSIONS: The upregulation of oxidative stress-related and hypertrophic pathways constitutes the universal hallmarks of the cardiomyocyte response elicited by T. cruzi infection. Nitrogen metabolism upregulation and glutathione metabolism imbalance may implicate a relationship between nitrosative stress and poor oxygen radicals scavenging in the unique pathophysiology of Chagas cardiomyopathy.

Diagnóstico antenatal de cardiopatías congénitas por telemedicina: experiencia en CERPO, 2017-2022 / Antenatal diagnosis of congenital heart disease by telemedicine: experience in CERPO, 2017-2022

Introducción: Las cardiopatías congénitas son las anomalías más frecuentes y la principal causa de muerte infantil y neonatal. El diagnóstico prenatal mejora el resultado perinatal determinando el lugar de nacimiento y el nivel de cuidado neonata. La telemedicina mediante videoconferencia en tiempo real permite mejorar la precisión diagnóstica y planificar el nacimiento. Objetivo: Determinar el diagnóstico y manejo perinatal de fetos con sospecha de cardiopatía congénitas, evaluadas a través de telemedicina en tiempo real atendidas en CERPO en el periodo 2017-2022. Material y métodos: Estudio retrospectivo de las evaluaciones mediante telemedicina en tiempo real realizadas en CERPO entre los años 2017 a 2022. Se revisó el resultado perinatal y se compararon los diagnósticos pre y postnatales, extraídos de la base de datos CERPO y Unidad de Neonatología del Hospital Luis Tisné Brousse. Resultados: La correlación del diagnóstico de cardiopatía congénita mediante telemedicina es de un 81,8% y de 89,8% con el diagnostico posnatal. Conclusiones: La evaluación por medio de telemedicina permite mejorar la precisión diagnostica de la cardiopatía congénita en áreas con escaso acceso a operadores experimentados en evaluación cardiaca fetal. Esto minimiza el impacto económico y social asociado al manejo perinatal de un feto con cardiopatía congénita en nuestro país.

Introduction: Congenital heart disease is the most common anomaly and the leading cause of infant and neonatal death. Prenatal diagnosis improves perinatal outcomes by choosing the right place of birth and level of neonatal care. Telemedicine by videoconferencing in real-time allows for improved diagnostic accuracy and birth planning. Objective: To determine the diagnosis and perinatal management of fetuses with suspected congenital heart disease, evaluated by telemedicine at CERPO in the period 2017-2022. Material and Methods: Retrospective study of evaluations via real-time videoconferencing performed at CERPO between 2017-2022. The perinatal outcome was reviewed, and pre and postnatal diagnoses were compared. The data was extracted from the CERPO database and the Neonatology Unit of the Luis Tisné Brousse Hospital. Results: The correlation of congenital heart disease diagnosis by telemedicine was 81.8% and 89.8% with postnatal diagnosis. Conclusions: Telemedicine assessment improves the diagnostic accuracy of congenital heart disease in areas with poor access to an experienced fetal cardiac specialist. This minimizes the economic and social impact associated with our countrys perinatal management of a fetus with congenital heart disease.

Cuidados de la placenta y seguridad del recién nacido en el nacimiento Lotus / Placenta care and newborn safety in Lotus Birth

OBJETIVO: revisar la evidencia científica referente a los cuidados de la placenta y a la seguridad del recién nacido en el nacimiento Lotus. MÉTODO: revisión narrativa. Se llevaron a cabo diferentes estrategias de búsqueda en las siguientes bases de datos y plataformas: Pubmed, Cochrane, Ovid, Scielo, Cuiden, Clinical key, BMJ, Metas de Enfermería y Google Scholar. Palabras usadas: Lotus birth, umbilical non severance, cord clamping, care, safety, nacimiento Lotus. Filtros: 2016-2020, sobre cuidados placenta y seguridad recién nacido, estudios epidemiológicos. RESULTADOS: se localizaron 169 documentos. Se seleccionaron seis artículos. En dos artículos se trataban los cuidados de la placenta que eran lavadas con agua tibia en las primeras horas, secadas y envueltas en paños de tejidos naturales, usando sales y hierbas aromáticas para acelerar el proceso de secado, y dejándola a la altura del recién nacido. En los otros cuatro documentos se describían seis casos de complicaciones infecciosas que se resolvieron con antibioterapia, en madres que habían presentado bolsa rota prolongada, cultivos vaginales positivos y ausencia de antibioterapia periparto. DISCUSIÓN: el Lotus birth es una práctica infrecuente, asociada tradicionalmente al parto domiciliario, que se va introduciendo en el medio hospitalario. Es escasa la evidencia disponible sobre los cuidados de la placenta en el nacimiento Lotus y la seguridad de esta práctica para los recién nacidos

OBJECTIVE: to review the scientific evidence regarding placenta care and newborn safety in Lotus Birth. METHODS: a narrative review. Different search strategies were conducted in the following databases and platforms: Pubmed, Cochrane, Ovid, Scielo, Cuiden, Clinical key, BMJ, Metas de Enfermería and Google Scholar. Terms used: Lotus Birth, umbilical non severance, cord clamping, care, safety, nacimiento lotus. Filters: 2016-2020, on placenta care and newborn safety, epidemiological studies. RESULTS: in total. 169 documents were located. Six articles were selected. Two articles discussed placenta care: they were washed with warm water during the first hours, dried and wrapped in natural fabric cloths, using salts and aromatic plants to accelerate the drying process, and placed at the same height as the newborn. The other four documents described six cases of infectious complications, which were solved with antibiotic therapy, in mothers who had presented prolonged broken sac, positive vaginal cultures, and lack of peripartal antibiotic therapy. DISCUSSION: Lotus Birth is a rare practice, traditionally associated with home births, which has been increasingly introduced in the hospital setting. There is limited evidence available about placenta care in Lotus Birth, and the safety of this practice for newborns

Atividades da vida diária de pacientes após transplante pulmonar / Daily life activities of patients after lung transplantation

Objetivo: conhecer as atividades da vida diária através da percepção dos pacientes sobre os cuidados após o transplante pulmonar. Metodologia: estudo descritivo, com abordagem qualitativa, através de grupo focal com 10 pacientes, no período de março a abril de 2018. Na análise dos dados foi utilizada a análise do conteúdo. Respeitaram-se os princípios éticos da pesquisa envolvendo seres humanos e o estudo foi aprovado pelo Comitê de Ética com o número 1.146.838. Resultados: emergiram três categorias temáticas: Atividades da vida diária; Cuidados após o transplante pulmonar e Nível de entendimento. Conclusão: o estudo identificou que os pacientes desenvolveram atividades de autocuidado como tomar banho sozinho e comer sem ajuda, modificaram hábitos alimentares, e aumentaram os cuidados com as medicações prescritas. (AU)

Objective: To know the activities of daily living through the perception of patients about care after lung transplantation. Methodolgy: a descriptive study with a qualitative approach through a focus group with 10 patients, from March to April 2018. In the data analysis was used the content analysis. The ethical principles of research involving human subjects were respected and the study was approved by the Ethics Committee under number 1.146.838. Results: three thematic categories emerged: instrumental activities of daily living; Care after lung transplantation and Level of understanding. Conclusion: The study found that patients developed self-care activities such as bathing alone and eating unaided, modified eating habits, and increased care with prescribed medications. (AU)

Objetivo: Conocer lãs actividades de la vida diária através de La percepción de los pacientes sobre la atención después del trasplante pulmonar. Metodología: um estúdio descriptivo com um enfoque cualitativo através de um grupo focal com 10 pacientes, de marzo a abril de 2018. En el análisis de datos se utilizo el análisis de contenido. Se respetaron los princípios éticos de la investigación en seres humanos y el estúdio fue aprobado por el Comitê de Ética con el número 1.146.838. Resultados: surgieron tres categorias temáticas: actividades de la vida diária; Atención después del trasplante de pulmón y nível de comprensión. Conclusión: el estúdio encontro que los pacientes desarrollaron actividades de autocuidado como bañarse solo y comer sin ayuda, hábitos alimentícios modificados y uma mayor atención con medicamentos recetados. (AU)

Cuidados de la matrona en la versión cefálica externa / Midwife care in external cephalic version

La versión cefálica externa (VCE) es una maniobra obstétrica que intenta convertir una presentación fetal podálica o transversa en cefálica, más favorable de cara al parto. La matrona, como parte del equipo multidisciplinar, está presente durante el proceso de su realización, aplicando los cuidados necesarios para una atención integral de la mujer gestante. El objetivo de este artículo es presentar el caso clínico de una mujer embarazada durante el procedimiento de VCE. Se elabora el plan de cuidados enfermeros basado en las necesidades básicas de Virginia Henderson y guiado por la taxonomía NANDA-NIC-NOC, donde se identifican tres diagnósticos de Enfermería, que serán la base de la realización de este proceso enfermero: temor, dolor agudo y riesgo de alteración de la díada materno/fetal. La aplicación de este plan de cuidados supuso una mejora en la atención a la mujer y en la organización del trabajo

External cephalic version (ECV) is an obstetric manoeuvre intended to change a breech or transversal fetal presentation into cephalic, more favourable in terms of delivery. The midwife, as a member of the multidisciplinary team, will be present during this procedure, implementing any necessary measures for a comprehensive care of the pregnant woman. The objective of this article is to present the clinical case of a pregnant woman during the ECV procedure. The nursing care plan is prepared on the basis of Virginia Henderson’s basic needs, and guided by the NANDA-NIC-NOC taxonomy, where three nursing diagnoses will be identified as the basis for conducting this nursing process: fear, acute pain and risk of alteration of the maternal/fetal dyad. The application of this healthcare plan represented an improvement in women care and work organization

Zika virus-induced neurological critical illness in Latin America: Severe Guillain-Barre Syndrome and encephalitis.

Zika virus (ZIKAV) is classically described as causing minor symptoms in adult patients, however neurologic complications have been recognized. The recent outbreak in Central and South America has resulted in serious illness in some adult patients. We report adult patients in Latin America diagnosed with ZIKAV infection admitted to Intensive Care Units (ICUs). METHODS: Multicenter, prospective case series of adult patients with laboratory diagnosis of ZIKAV in 16 ICUs in 8 countries. RESULTS: Between December 1st 2015 and April 2nd 2016, 16 ICUs in 8 countries enrolled 49 critically ill patients with diagnosis of ZIKAV infection. We included 10 critically ill patients with ZIKAV infection, as diagnosed with RT-PCR, admitted to the ICU. Neurologic manifestations concordant with Guillain-Barre Syndrome (GBS) were present in all patients, although 2 evolved into an encephalitis-like picture. 2 cases died, one due to encephalitis, the other septic shock. CONCLUSIONS: Differing from what was usually reported, ZIKAV infection can result in life-threatening neurologic illness in adults, including GBS and encephalitis. Collaborative reporting to identify severe illness from an emerging pathogen can provide valuable insights into disease epidemiology and clinical presentation, and inform public health authorities about acute care priorities.

Uso de analgesia epidural y valores de pH y Apgar del recién nacido / Use of epidural analgesia and pH value and Apgar score in newborns

Objetivo: evaluar las diferencias en los resultados neonatales (pH y de Apgar en el recién nacido) entre las mujeres que dieron a luz en el paritorio del Hospital Universitario de Burgos con analgesia epidural (AE) y sin ella. Método: estudio de cohorte retrospectivo en 15.506 partos eutócicos atendidos entre 2002 y el 2015 (9.739 con y 5.767 sin AE). Variables dependientes: pH de arteria umbilical fetal (< 7,10), Apgar al minuto (< 7), Apgar a los cinco minutos (< 7). Para el análisis bivariante se utilizó la prueba no paramétrica U de Mann-Whitney y el test de Chi cuadrado. Resultados: la media de pH fue 7,26 y 7,23, grupo sin AE y con AE respectivamente (p< 0,0001). El porcentaje de pH< 7,10 fue 2,7% y 4,3%, grupo sin AE y con AE, respectivamente (p< 0,0001). La media de Apgar al minuto fue 8,88 y 8,79, grupo sin AE y con AE, respectivamente (p< 0,0001). El porcentaje de Apgar al minuto < 7 fue 1,1% y 2,4%, grupo sin AE y con AE respectivamente (p< 0,0001). La media de Apgar a los cinco minutos fue 9,92 y 9,87, grupo sin AE y con AE, respectivamente (p < 0,0001). El porcentaje de Apgar a los cinco minutos < 7 fue 0,1% y 0,2%, grupo sin AE y con AE, respectivamente (p= 0,045). Conclusiones: el grupo de mujeres con AE tenía recién nacidos con menor pH, menor Apgar al minuto y a los cinco minutos. Está asociado el uso de analgesia epidural con peores resultados neonatales (AU)

Objective: to evaluate the differences in neonatal scores (pH and Apgar in newborns) among women who gave birth in the delivery room of the Hospital Universitario de Burgos with and without epidural analgesia (EA). Method: a retrospective cohort study in 15,506 normal deliveries managed between 2002 and 2015 (9,739 with and 5,767 without AE). The dependent variables were: fetal umbilical artery pH (< 7.10), Apgar at 1 minute (< 7), Apgar at 5 minutes (< 7). The non-parametric Mann-Whitney U test and the Chi-Square Test were used for bivariate analysis. Results: the mean pH was 7.26 and 7.23, for the groups without EA and with EA respectively (p< 0.0001). The proportion of pH< 7.10 was 2.7% and 4.3%, for the groups without EA and with EA respectively (p< 0.0001). The mean Apgar score at 1 minute was 8.88 and 8.79, for the groups without EA and with EA respectively (p< 0.0001). The proportion of Apgar at 1 minute < 7 was 1.1% and 2.4%, respectively for the groups without EA and with EA (p< 0.0001). The mean Apgar score at five minutes was 9.92 and 9.87, respectively for the groups without EA and with EA (p < 0.0001). The proportion of Apgar at five minutes < 7 was 0.1% and 0.2%, respectively for the groups without EA and with EA (p= 0.045). Conclusions: the group of women with EA gave birth to babies with a lower pH, and lower Apgar score at 1 minute and at 5 minutes. The use of epidural analgesia was associated with worse neonatal results (AU)

Influencia de la edad materna avanzada en la incidencia de cesárea / The influence of advanced maternal age upo the incidence of C-sections

OBJETIVO: describir la incidencia de cesárea en el Hospital Universitario de Burgos (HUBU) de 2004 a 2014; así como explorar la influencia de la edad materna avanzada, teniendo en cuenta dos edades de corte (35 y 40 años), en dicha incidencia. MATERIAL Y MÉTODO: estudio descriptivo longitudinal retrospectivo (2004-2014) sobre los 24.521 partos realizados en el HUBU. Se utilizó el registro informatizado de partos. La variable principal del estudio fue la cesárea, y la variable independiente, la edad de la mujer, teniendo en cuenta dos edades de corte (mayores de 40 vs. iguales o menores de 40 años; mayores de 35 vs. iguales o menores de 35 años). Se utilizó prueba z para el contraste de hipótesis; se calcularon intervalos de confianza (IC) al 95% de seguridad. RESULTADOS: se contó una población de 24.426 partos. La diferencia de incidencia de cesárea entre mayores de 40 e igual o menor de 40 años fue de un 11% (IC 95%: 8%-14%; p< 0,001) a favor de una mayor incidencia en la mayores de 40. Atendiendo a la edad de corte de 35 años, esta diferencia fue de un 5% (IC 95%: 3,8%-6,2%; p< 0,001), y en la misma dirección anteriormente señalada. La incidencia acumulada global de cesárea fue del 22,5% (IC 95%: 21,98%-23,02%). CONCLUSIÓN: existen diferencias en la incidencia de cesárea en función de la edad, independientemente del corte de edad a los 35 o a los 40 años, y con una mayor incidencia en las más mayores. Cabe preguntarse el efecto de las técnicas de reproducción asistida y el posible aumento de cesáreas electivas

OBJECTIVE: to describe the incidence of C-sections at the Hospital Universitario de Burgos (HUBU) from 2004 to 2014; as well as to explore the influence of advanced maternal age, considering two cut-off ages (35 and 40 years) for said incidence. MATERIAL AND METHODS: a descriptive longitudinal retrospective study (2004-2014) on the 24,521 labours conducted at the HUBU. The computerized record of labours was used. The primary variable of the study was C-section, and the independent variable was maternal age, considering two cut-off ages (>40-year-old vs. is less than or equal to40 year-old; >35-year old vs. is less than or equal to35-year-old). The z-test was used for hypothesis contrast, and a 95% confidence interval (CI) was estimated. RESULTS: the study included a population of 24,426 labours. The difference in the incidence of C-sections between >40-year old and is less than or equal to40-year-old was 11% (CI 95%: 8%-14%; p< 0.001), showing a higher incidence in >40-year-old women. Regarding the cut-off age of 35 years, the difference was 5% (CI 95%: 3.8%-6.2%; p< 0.001), and in the same direction previously mentioned. There was an overall cumulative incidence of C-sections of 22.5% (CI 95%: 21.98%-23.02%). CONCLUSION: there are differences in the incidence of C-sections based on age, regardless of the cut-off age of 35 or 40 years, showing a higher incidence in older mothers. It is worth considering the effect of assisted reproduction techniques, and the potential increase in elective C-sections

Evolución de la tasa de episiotomías en el Hospital Universitario de Burgos y su relación con los resultados perineales y neonatales / Evolution of the rate of episiotomies in the University Hospital of Burgos and its relation with perineal and neonatal outcomes

OBJETIVO: Analizar la evolución del uso de episiotomías en el Hospital Universitario de Burgos en relación con la implantación de la Estrategia de Atención al Parto Normal (EAPN), y valorar su relación con los resultados maternofetales. MÉTODO: Estudio correlacional retrospectivo. Se estudiaron los partos eutócicos y los recién nacidos a término en parto eutócico entre el 1 de enero de 2002 y el 31 de diciembre de 2013. Las variables estudiadas fueron las siguientes: paridad, realización o no de episiotomía, desgarro perineal, test de Apgar y pH de arteria umbilical. El análisis de los datos se realizó mediante técnicas paramétricas de contraste de hipótesis. RESULTADOS: Del total de 26.163 partos atendidos en el Hospital Universitario de Burgos durante el periodo citado, se incluyeron 16.222 partos eutócicos, y para el estudio de resultados fetales 15.132 recién nacidos. El porcentaje de episiotomías en partos eutócicos disminuyó significativamente (p <0,001) del 92,36 al 43,09%. La comparación de los datos antes y después de la EAPN muestra una disminución del porcentaje de episiotomías del 71,40 al 47,30%. Respecto a las lesiones perineales, con y sin epi-siotomía, se encontraron diferencias en el porcentaje de perinés íntegros (del 0 frente al 32,26%), pero no en el porcentaje de desgarros graves. Además, no se hallaron diferencias en los resultados del test de Apgar ni en el pH que indicaran unos peores resultados neonatales sin episiotomía. CONCLUSIONES: El porcentaje de episiotomías ha disminuido significativamente. No se encontró ninguna relación entre los partos sin episiotomía y un mayor porcentaje de daños perineales graves ni unos peores resultados neonatales. Aumentó el porcentaje de perinés íntegros al no realizar episiotomías

OBJECTIVE: To analyze the evolution in the use of episiotomy in the University Hospital of Burgos, regarding the establishment of the Strategy for Assistance at Normal Childbirth; and evaluate its relation with fetal and maternal outcomes. METHODS: Cross-sectional retrospective study in the University Hospital of Burgos. From the 26,163 deliveries between 1/1/2002 and 12/31/2013 only normal vaginal deliveries were included (16,222); and for the study of the fetal outcomes only term newborns with normal vaginal birth (15,132). The variables used were: parity, episiotomy, perineal tears, Apgar score and pH of umbilical artery. Data analysis was delivered with parametric tools of hypothesis testing. RESULTS: The rate of episiotomy in normal vaginal births decreased significantly (p <0.001) from 92.36 to 43.09%. Data contrast between before and after the Normal Delivery Strategy show a decrease in the rate of episiotomy from 71.40 to 47.30%. Concerning perineal tears with and without episiotomy, we found a difference in the rate of intact perineum (from 0 to 32.26%); but no difference at all in the rate of third and fourth degree lacerations. Neither were differences in the Apgar score or pH that could indicate worst neonatal outcomes without episiotomy. CONCLUSIONS: Our episiotomy rate has decreased significantly; not showing statistic relation between deliveries without episiotomy and higher rates of third and fourth degree lacerations, or with worst neonatal outcomes. There is, indeed, relation between not performing episiotomy and an increase in the intact perineum rate

[Relationship between domestic violence during pregnancy and risk of low weight in the newborn]. / Relación entre la violencia familiar durante el embarazo y el riesgo de bajo peso en el recién nacido.

OBJECTIVES: To determine the prevalence and characteristics of domestic violence before and during pregnancy, and its impact on obstetrical and perinatal outcomes, as well as to identify the main variables associated to domestic violence during pregnancy. PATIENTS AND METHODS: From August to September 2004, 288 consecutive women in the puerperium period were screened for a cross-sectional study in the Hospital General Dr. Manuel Gea Gonz6lez. The Abuse Assessment Screen and the IPPF screening instrument were used to measure emotional and physical abuse during pregnancy. Outcome data included miscarriage, cesarean delivery, gestational age, birth weight and Apgar score. Odds ratios and 95% confidence intervals were calculated to measure the associations between maternal characteristics, perinatal outcome and violence. RESULTS: The prevalence of domestic violence during pregnancy was 39.24%. Emotional abuse was the most prevalent type before and during pregnancy (94.71 and 96.46%, respectively) whereas the frequency of physical and sexual decreased during pregnancy. Domestic violence 12 months before pregnancy increased risk of low birth weight (OR: 1.69; 95% CI: 1.01-2.81), and miscarriage (OR: 2.09; 95% CI 1.14-3.83). The exposure to domestic violence anytime before pregnancy (OR: 3.13; 95% CI 1.48-6.63) and 12 months before pregnancy (OR: 12.79; 95% CI 6.38-25.6) increased risk of domestic violence during pregnancy. CONCLUSIONS: Violence before and during pregnancy is common and is associated with adverse maternal and perinatal outcomes. There is a critical need to include a routine screening in the obstetric and gynecologic services and to provide medical and social services.

[Domestic violence: an approach from gynecology and obstetrics]. / Violencia familiar: una aproximación desde la ginecología y obstetricia.

Violence against women represents a serious violation of women's human rights and has been recognized as a clinical and public health problem, independently of nationality, ethnicity, cultural norms and socioeconomic status. One of the most common forms of violence against women is that perpetrated by an intimate male partner. The intimate partner violence has short-term and long-term negative health consequences, which provoke a poor quality of life with high use of health services, and even the suicide and homicide of women. Specifically, abuse during pregnancy is associated with sexually transmitted diseases, anemia, first and second trimester bleeding, less than optimal weight gain, deleterious perinatal outcomes (low birth weight, miscarriage, and fetal distress) and maternal or infant deaths. The purpose of this review is to emphasize the serious health consequences of the partner violence, and to compile the studies that have measured violence during pregnancy, particularly in Latin America.

[Attitudes and hierarchy of medical values in a gynecology and obstetrics department]. / Actitudes y jerarquía de valores en un servicio de ginecología y obstetricia.

BACKGROUND: The current practice of medicine is suffering a deep crisis of values due to the process of super-specialization, marketing tendencies, growing and the practice of a defensive medicine. OBJECTIVE: To examine the attitudes and hierarchy of medical values in undergraduate students, residents and faculty physicians in an obstetrics and gynecology department. MATERIAL AND METHODS: A descriptive, open, observational and transversal study was done, in which a questionnaire including a demographic data-record and 22 questions related to values and attitudes was applied to 29 individuals belonging to the medical staff of the gynecology and obstetrics service at Hospital General Dr. Manuel Gea Gonzalez. RESULTS: Medical knowledge, honesty and respect were consistently mentioned as the most emphasized characteristics across the examination. Benevolence and compassion were frequently indicated in undergraduate students, but not in third year residents and specialists. Respect for the right of individual patients to make their own choices about their health care, in some doctors, is a problematic issue. CONCLUSIONS: The teaching of professionalism is important in residency training and is expected to be an equal partner in the triad of knowledge, skills and values.

[Current concepts of venous thromboembolism and anticoagulation during pregnancy]. / Conceptos actuales en tromboembolismo venoso y anticoagulación durante el embarazo.

The pregnancy is a physiologic state with an elevated risk for thromboembolic complications. Clinical diagnosis and many diagnostic tests are less accurate in pregnant than in nonpregnant patients. The principal indications for anticoagulation during pregnancy include treatment and prophylaxis of deep vein thrombosis and pulmonary embolism, and prevention of pregnancy loss in women with antiphospholipid antibodies. However, the use of anticoagulants may produce complications in the fetus, as well as in the mother. This paper provides recommendations for the safe use of anticoagulants during pregnancy.